Healthcare Provider Details

I. General information

NPI: 1063143790
Provider Name (Legal Business Name): BERENICE JEACEL ESPINOZA FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERENICE JEACEL CAMARENA MOJICA

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 WESTERN AVE
KINGMAN AZ
86409-3291
US

IV. Provider business mailing address

1111 RIATA VALLEY RD STE B
KINGMAN AZ
86409-3678
US

V. Phone/Fax

Practice location:
  • Phone: 888-209-8874
  • Fax:
Mailing address:
  • Phone: 928-277-3947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN205093
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP279966
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: